Home Cosmetic Surgery General Cosmetic Surgery in a Multicultural Society

Cosmetic Surgery in a Multicultural Society

Sydney plastic surgeon Dr Darryl Hodgkinson discusses rhinoplasty in the ethnic patient.

Practicing cosmetic plastic surgery in a multicultural society such as Sydney, New York and London affords exposure to a wide variety of people with different ethnic backgrounds seeking aesthetic surgery.
This is the first of a two-part series on my approach to different ethnic sub-groups over the past 30 years, practicing in the Eastern Suburbs of Sydney for nearly 20 years and over 10 years performing plastic surgery in the United States.

The next census will reveal more accurately Australia’s current ethnic diversity, but all Australians are aware of the great success of our immigration policies since World War II , with the near doubling of the population due to new Australians coming from every continent and cultural background imaginable. This increase in ethnic groups demands that the cosmetic plastic surgeon have an understanding of the social, cultural and aesthetic values of patients from these different groups when they seek cosmetic surgery. It has also been shown that firstgeneration new Australians seek an aesthetic which is a hybrid of their own cultural background and their new environment. In this first section, I will focus on rhinoplasty and the cosmetic surgical approaches to the Middle Eastern and the Asian nose in particular.

Before and after rhinoplasty by Dr Hodgkinson
Before and after rhinoplasty by Dr Hodgkinson
 Before and after rhinoplasty by Dr Hodgkinson
Before and after rhinoplasty by Dr Hodgkinson

Features common to many Middle Eastern noses usually include a strong, prominent nose with a high bridge, a wide middle area of nose and a bulky tip or sometimes drooping tip. This type of nose may appear slightly long in relationship to the face in the frontal view of photographs and in profile or the three-quarter view, a hump or drooping tip might distort the balance of the facial features. Accentuation of the nose in photographs, especially those taken with phone cameras or small digital cameras, is due to the fact that these cameras have lenses with a short focal distance that accentuates the middle third of the face or image being taken.

The aesthetics and appearance of the Asian face is quite different. As opposed to having strong noses with high bridges, the Asian nose is often flat, with a wide and depressed tip. In profile, there is generally very little projection to the nose and it may even appear ‘scooped out’. This therefore calls for an entirely different approach. This type of nose needs to be enhanced or augmented, often with a bone graft or cartilage graft to the bridge of the nose to build up the ‘flatness’. Synthetic grafts like silicone are avoided as they can be rejected over time and do not bond as well to the existing nasal structures as the patient’s own tissues. At the same time, the nose is given height and projection with a graft, the flare of the nostrils can be narrowed to give the female nose an overall more elegant appearance or the male nose a stronger look.

In assessing any patient, perhaps the most important pitfall to avoid is the myth that there is such a thing as a ‘perfect nose’. There is no nose which will look good on everyone’s face. Herein lies the challenge for the surgeon: to be able to conceive a nose that is appropriate for and will look balanced on a face. The skills for this are not taught nor can they be. The aesthetic judgment of the surgeon, the many years of experience and all the techniques used in plastic surgery have to come together with the desires of the patient for the outcome to be right.

This process and communication with the patient about their desires can be aided with digital imaging prior to the surgery in order to ‘arrive’ at an appropriate aesthetic design which fits the overall appearance of the face. This is somewhat akin to the construction of any art project, whether it be painting, sculpture or architecture, in that the formal features of the design are complementary to each other. No one feature is overly prominent or stands out and all fit together so the overall appearance (the artwork) is enhanced, with the individual components working in unison and harmony.